“I Used My Courage”: A Strategy for Facing Internal Challenges to Nursing Practice

“Nan, Nan. Do you know what I did?” I was FaceTime chatting with my 6-year-old grandson, and he was telling me about the fieldtrip his class went on that day. He is always exuberant, always sharing his 6-year-old wisdom.

“What did you do?”

“I petted a snake.”

“Oh, my. Weren’t you afraid?”

“No.” He shrugged his shoulders. “I used my courage.”

I love this line. It seems like a good philosophy for all of us. When I am hesitant to do something or uncomfortable about trying, I think of his words. Those times when I hesitate because I am afraid, in whatever form that may take: afraid I might not do it well, afraid doing it will anger someone, afraid because I’ve never done it before. Remembering that fear and courage are linked.

The saying out of the mouth of babes is so true. Kids are matter-of-fact about things an adult would never admit to. They are brilliant in their innocence. Somehow, as we get older and lose some of that innocence, we also let go of looking at things very simply. We make things more complex than they need to be, adding layers of difficulty to shore up the walls we erect. Oh, to be able to say very humbly and sincerely, “I used my courage.” But I also like the idea of how he said my courage, meaning his courage was there and available to use.

All of us have had patients or families who challenged our practice. But layered onto the complexity of their care is our personal response. Perhaps it was uncomfortable because of a personality mismatch or an ethical dilemma. These are the situations in which we tell and retell the story, “I’ll never forget Mr X, he was in room 127 and …”

We live with the “and …” part of the story, maybe with satisfaction over how we handled a difficult situation, or regret, or sometimes with a totally blunted response. I may even take that discomfort and project it to the patient: He was so difficult. The family just didn’t get it. The bottom line is something made us uncomfortable. Addressing that discomfort takes courage. I used my courage. What might that look like?

It may be easier to say be brave, use your courage than it is to acknowledge there is a need to be brave. The idea of taking time to examine our response when we are expected to quickly move on to the next patient and their needs does not allow for reflection. Easier to push it down. After a while we almost forget the stress of it. Almost. This makes me think of our patients when we ask “how are you doing?” and they say “I’m fine.” Yet we look at them and know it isn’t true. It is easy to see that as a nurse, harder to see the emotional pain we may be masking from ourselves and others. I have heard nurses say, “It was really difficult. But I’m okay, really I’m okay.” Sometimes the statement, but I’m okay is repeated so many times it becomes difficult to believe.